Cleft and hearing

The ear is a complicated mechanism, and there are several different reasons why someone might have hearing issues or hearing loss.

Children born with a cleft palate are more likely to have hearing loss due to middle ear problems, specifically ‘glue ear’.

There is a thin tube running from the middle ear to the back of the nose and throat. This tube helps to equalise the pressure between these two areas; you may notice this when swallowing or when you ‘pop’ your ears.

The muscles of the soft palate are an important part of helping this tube to work properly. If these muscles don’t work quite how they should, this tube can become clogged, leading to ‘glue ear’.

In the majority of cases, these problems clear up by around 6-8 years old. Occasionally they can lead to longer-term hearing issues which will be managed by your Cleft Team.

Glue Ear (also called Otitis Media with Effusion, or ‘OME’) is a very common childhood condition. The NHS estimates around 80% of all children (with or without a cleft) have it at some point before they are ten years old.

Why does it happen?

This is thought to happen when the eustachian tube doesn’t function properly. This is a thin tube which runs from the middle ear to the back of the nose and throat, and it works by equalising air pressure between these two areas, sort of like what happens when you “pop” your ears.

If it doesn’t work properly, there may be a difference in air pressure between the middle ear and the nose. This can cause the middle ear to fill with fluid which can thicken over time to a glue-like texture. This blocks the middle ear and can make it hard to hear and can cause earaches.

Having glue ear can make it sound as if you are underwater, with sounds being muffled and harder to hear, especially if they are quieter or if there is lots of background noise.

Does a cleft palate cause glue ear?

Glue ear is very common and has a lot of causes. A cleft palate can make it more difficult for the eustachian tube to work as it should, so these children are more likely to develop glue ear.

Boys are more likely than girls to develop glue ear, as are formula-fed babies.

How is it treated?

Glue ear is often temporary and can get better on its own, but sometimes treatment is needed. Children with a cleft palate are more likely to need treatment. See below for more information.

No. If your child has a cleft lip and no cleft palate, they are not at any extra risk for hearing issues.

There are lots of reasons why a child might have hearing issues, and a cleft palate is only one of these. If you have any concerns about your child’s hearing, you should still get them tested so they can get any necessary treatment.

Grommets are tiny plastic tubes placed in the eardrum. They need to be placed during an operation under general anaesthetic.

These allow the air pressure in the back of the throat, nose and middle air to be equalised even if the eustachian tubes aren’t working as they should. See ‘glue ear’ above for more information.

T-tubes (a larger type of grommet that is less likely to fall out) are sometimes used in older children, but they are too big for most small children and are also more likely to cause scarring and perforation.

Advantages of grommets

• They aren’t visible to others.
• It is thought that grommets could help prevent middle ear damage, since there is a possibility that long-term glue ear can cause ear damage if it is left untreated.
• They can help with earaches.
• They do not require maintenance once they’re in.

Disadvantages of grommets

• Inserting grommets requires an operation and therefore general anaesthetic, which is why they are often inserted during a palate repair or another surgery.
• Grommets often fall out as the eardrum heals (after around 6-12 months), and if the glue ear comes back, another procedure under general anaesthetic to replace the grommets may be necessary, and this may happen several times.
• You may also be advised against letting your child swim in certain kinds of water, or to take certain precautions against letting your child’s ears come into contact with dirty water which may end up in the middle ear.
• In rare cases, grommets can cause infections, and occasionally perforations (holes) and scarring to the ear drum.

Great Ormond Street Hospital: Glue ear and grommets

Hearing aids can boost a child’s hearing without the need for an operation. These are usually suitable for children with any level of hearing loss.

Hearing aids come in several different kinds, and the most suitable one for your child will be recommended by the Audiologist or ENT consultant.

Advantages of hearing aids

• They can boost hearing without the need for an operation
• They are usually suitable for children with any level of hearing loss

Disadvantages of hearing aids

• Children can’t wear them all the time, such as when they’re in bed or when swimming.
• They require maintenance, such as new moulds as a child’s ears grow, batteries, someone needs to know how to turn them on and off and how to adjust volume settings.
• They are visible. However, younger children tend to cope with hearing aids very well in this respect. Their friends don’t tend to notice anything different about them.
• Hearing aids don’t help to prevent middle ear damage from long-term glue ear.

The options for treating hearing issues caused by a cleft each have their advantages and disadvantages. One is not necessarily better than the other.

Your Cleft Team may recommend one of these options, or they may leave the choice entirely up to you. Listen carefully to their reasons for recommending each one, and make a choice which is right for you and your child, keeping in mind the limitations and obligations that come with each.

It is possible to use grommets and hearing aids together, though this could increase the chances of infection. If this is the treatment option and the child does develop an infection, the grommets may have to be removed.

Other treatments can include using decongestants or nasal sprays to clear out the middle ears.

In some cases, your cleft team may recommend waiting to see if the issues get better on their own without treatment. They should clearly explain their reasons for this and tell you when you can expect a follow-up, but do speak up if you have any concerns about this.